Alvin C Kwok1, Jayant P Agarwal1. 1. University of Utah, School of Medicine, Division of Plastic Surgery, 30 N 1900 E, 3B400, Salt Lake City, Utah, 84132.
Abstract
PURPOSE: Our intent was to evaluate unplanned reoperations as a quality indicator for microvascular free tissue transfer (MFTT). METHODS: The National Surgical Quality Improvement Program database was used to identify MFTT cases from January 2012 to December 2013. Multivariate logistic regression models were used to determine risk factors for unplanned reoperations. RESULTS: We identified 2,244 MFTT cases. There were 290 associated unplanned reoperations (12.92%). There was a threefold increase in the rate of complications when patients underwent reoperation (58.28% vs 18.12%, p < 0.0001). Head and neck reconstructions had the highest rate of reoperations (18.04%). Most reoperations were debridements (38.28%), followed by microvascular procedures (28.97%) and flap revisions (26.55%). American Society of Anesthesiologist (ASA) classification ≥3 [OR 1.565, 95% CI (1.204, 2.034), p = 0.0008] and prolonged operative time [OR 1.597, 95% CI (1.221, 2.089), p = 0.0006] were significant independent risk factors for reoperations. CONCLUSIONS: Unplanned reoperations are a useful quality indicator for MFTT. ASA classification ≥3 and prolonged operative time were risk factors associated with an increased risk for unplanned reoperations.
PURPOSE: Our intent was to evaluate unplanned reoperations as a quality indicator for microvascular free tissue transfer (MFTT). METHODS: The National Surgical Quality Improvement Program database was used to identify MFTT cases from January 2012 to December 2013. Multivariate logistic regression models were used to determine risk factors for unplanned reoperations. RESULTS: We identified 2,244 MFTT cases. There were 290 associated unplanned reoperations (12.92%). There was a threefold increase in the rate of complications when patients underwent reoperation (58.28% vs 18.12%, p < 0.0001). Head and neck reconstructions had the highest rate of reoperations (18.04%). Most reoperations were debridements (38.28%), followed by microvascular procedures (28.97%) and flap revisions (26.55%). American Society of Anesthesiologist (ASA) classification ≥3 [OR 1.565, 95% CI (1.204, 2.034), p = 0.0008] and prolonged operative time [OR 1.597, 95% CI (1.221, 2.089), p = 0.0006] were significant independent risk factors for reoperations. CONCLUSIONS: Unplanned reoperations are a useful quality indicator for MFTT. ASA classification ≥3 and prolonged operative time were risk factors associated with an increased risk for unplanned reoperations.
Authors: Jacob Veith; Willem Collier; Andrew Simpson; David Magno-Padron; Bruce Mast; Robert X Murphy; Jayant Agarwal; Alvin Kwok Journal: Plast Reconstr Surg Glob Open Date: 2020-05-27